Iliac neck dilatation causes rupture of abdominal aortic aneurysm previously treated with endovascular aortic aneurysm repair.

A 78-year-old male had undergone endovascular aortic aneurysm repair (EVAR) 7 years prior to presentation. Although the sac was stable 6 months ago, the patient presented with shock at arrival, and CT showed aortic rupture with rapid expansion due to type Ib endoleak caused by iliac neck dilatation (IND). The aneurysm sac was excluded using an endovascular strategy. Bell-bottom iliac limbs can cause IND associated with type Ib endoleak. Additionally, the risk of rupture is high when re-expansion of an aneurysm occurs after sac regression after EVAR. Therefore, close follow-up is mandatory for patients with IND after EVAR.

Two Cases of Surgical Correction of Recurrent Mitral Regurgitation due to Failed Catheter- Delivered Mitral Clip (MitraClip).

From April 2018 to February 2021, 150 patients underwent MitraClip implantation for severe functional mitral regurgitation (MR) at our hospital. Two of our patients, an 85-year-old man and an 84-year-old woman, developed a single leaflet device attachment in the acute phase after the implantation and had severe residual MR requiring surgical correction. The recurrent MR was first pointed out on day 5 and day 4, and the duration between MitraClip implantation and surgery was 13 and 55 days, respectively. Due to strong adhesions with the clips and severe valve damage after MitraClip implantation, both cases underwent mitral valve replacement with a good postoperative course. In patients with a high-risk baseline profile, surgical mitral valve replacement after failed MitraClip implantation should be considered at an optimal timing, and a detailed echocardiographic follow-up is required.

A Case of Acute Type A Aortic Dissection after Coronary Artery Bypass Grafting.

The patient was a 69-year-old man who underwent emergency surgery for acute aortic dissection that developed 5 months after coronary artery bypass grafting. The left internal thoracic artery (LITA) graft anastomosed to the left descending artery was not affected by the aortic dissection, and during the ascending aortic replacement, the artery was not identified for clamping. Although fully sufficient cardioplegia was not achieved due to the patent LITA graft, the patient's postoperative cardiac function was good. The two anastomotic sites of the vein grafts to the ascending aorta were excised along with a remnant of the aortic wall in an island fashion and were reimplanted onto the artificial graft. Based on the site of intimal tear, we speculated that partial clamping during the previous surgery had caused the dissection.

Midterm Results of Thoracic Endovascular Aortic Repair with Reentry Closure for Chronic Type B Aortic Dissection with Aneurysmal Dilatation.

Objectives: This study aims to discuss the midterm results of thoracic endovascular aortic repair (TEVAR) with reentry closure for chronic type B aortic dissection (CTBAD). Materials and Methods: This retrospective study analyzed 13 patients with CTBAD who underwent TEVAR with reentry closure between July 2014 and December 2020. We evaluated the false lumen (FL) cross-sectional area using computed tomography images of the descending aorta at the level of the bronchial bifurcation, Valsalva sinus, celiac artery, and infrarenal abdominal aorta pre- and postoperation. The study endpoints were technical and clinical success rates, freedom from additional aortic reintervention or surgery, and survival. Results: Technical success was obtained in 12 patients (92.3%) with no hospital mortality and neurological complications. The postoperative observation period was 49.2±21.5 months. The clinical success rate was 76.9% (10 cases), and a postoperative reduction of the FL cross-sectional area was obtained in 53.8% of patients. The 5-year overall survival rate was 64.8% with no aortic-related deaths while the 5-year freedom from additional aortic surgery rate was 66.7%. Conclusions: TEVAR with reentry closure suggests preventing FL dilatation or rupture in CTBAD, but the revision of our devices and further research with more patients and longer follow-up periods are required.

Longterm Followup of a Pediatric Patient with Congenital Abdominal Aortic Aneurysm with Coarctation.

Congenital abdominal aortic aneurysm (AAA) with coarctation has been considered an extremely rare condition. In this study, we present a 3-year-old boy, who was diagnosed by chance with congenital AAA at first operation. We replaced the AAA+coarctation with a 6-mm polytetrafluoroethylene (PTFE) graft. Histological examination of the aortic wall revealed no particular abnormalities. Collateral vessels were noted to develop over 14 years of followup. Good blood flow to both lower limbs and no intermittent claudication were observed. After growth, at the age 17, he underwent extra-anatomical bypass using a 12-mm PTFE graft. This is the first report of successful treatment of congenital AAA+coarctation with longterm followup.

Emergent Transcatheter Arterial Embolization via a Transpopliteal Approach for Internal Iliac Artery Injury during Lumbar Disk Surgery in the Prone Position.

This report describes a successful case of transcatheter arterial embolization for a critical vascular injury during lumbar disk surgery that resulted in a large retroperitoneal hematoma in a 72-year-old woman. A 4-Fr long sheath was inserted via the right popliteal artery in the prone position. Pelvic angiography revealed a pseudoaneurysm in the right internal iliac artery, which was managed with coil embolization. The patient underwent laparotomy because of abdominal compartment syndrome and was discharged in good condition after rehabilitation. The transpopliteal endovascular approach in the prone position may thus provide the best chance to treat this rare but critical condition.

Long-Term Clinical Outcomes of Cardiac Surgery for Kidney Transplant Patients.

PURPOSE: Immunosuppressant and steroid are inevitable for graft survival after renal transplantation, and their usage is known to be a risk factor for mortality and morbidity after cardiac surgery. We evaluated the long-term clinical outcomes in patients who underwent cardiac surgery after renal transplantation. METHODS: We retrospectively reviewed 23 patients who underwent cardiac surgery after renal transplantation with maintained grafts at the time of the cardiac surgery in our institution between June 2000 and June 2018 (19 males, 4 females; mean age, 55 (38-81) years). RESULTS: The interval from renal transplantation to cardiac surgery was 80.0 ± 84.6 (0.25-298) months. The mean follow-up period after cardiac surgery was 78.3 (range: 1-216) months. Cumulative survival rates at 1, 5, 7, and 10 years were 95.7%, 95.7%, 87.7%, and 68.2%, respectively. Renal graft survival rates at 1 and 5 years were 86.1% and 79.9%, respectively. CONCLUSIONS: This retrospective review suggests that cardiac surgery in kidney transplant patients can result in good survival rates. Thanks to dedicated postoperative and long-term management, approximately 80% of the renal grafts still maintained their function 5 years after cardiac surgery.

Posterior papillary muscle rupture after transapical transcatheter aortic valve implantation.

Transapical transcatheter aortic valve implantation is a well-established alternative in patients at a high risk for conventional aortic valve replacement. We performed transapical transcatheter aortic valve implantation on an 83-year-old woman with symptomatic severe aortic stenosis. Intraoperative transoesophageal echocardiography (TOE) after transcatheter aortic valve implantation showed mild mitral regurgitation without intracardiac structural injury. In the intensive care unit, the patient gradually had haemodynamic instability; TOE revealed severe mitral regurgitation with A2 and A3 prolapse due to rupture of the posterior papillary muscle. To repair the mitral regurgitation, mitral valve replacement was performed. Preoperative TOE revealed posterior displacement of the left ventricle due to right ventricular dilatation. Computed tomography showed the insertion angle of the guidewire from the left ventricular apex to the aortic valve as 95.6° and a relatively sharp angle of guidewire through the aortic valve. In such a case, it is necessary to carefully perform the catheter procedures to prevent intracardiac structure injury; posterior papillary muscle is particularly crucial.

Ventricular assist device implantation late after double switch operation for L-transposition of the great arteries.

We provided a left ventricular assist device (LVAD) for a 22-year-old man with congenital L-transposition of the great arteries after anatomic repair at the age of 7 years. He was hospitalized for progressive low-output syndrome caused by intractable biventricular failure. He received LVAD in his morphologic left ventricle with a concomitant pulmonary valve replacement. After the surgery, critical multiorgan failure with severe right heart failure occurred. It took three postoperative months to normalize all organ function following improvement of morphologic right ventricular function. He has remained stable with LVAD support for 1.5 years.

Clinical outcomes of pediatric ventricular assist device implantation: a single-institute report from Japan.

PURPOSE: Numerous difficulties remain associated with pediatric heart transplantation. Therefore, the development of a ventricular assist device (VAD) specific to these cases is extremely important for therapeutic effectiveness. We present 5 cases of severe heart failure that were managed by ventricular assist device implantation, as a bridge to transplantation. METHODS: We examined the clinical course of 5 patients (4 boys, 1 girl; mean age, 10.6 ± 1.5 years; range, 8-12 years) who underwent implantation of a pneumatic extracorporeal ventricular assist device between February 2004 and May 2009. Four patients had dilated cardiomyopathy and one had corrected transposition of the great arteries. RESULTS: The mean period between onset of heart failure and ventricular assist device implantation was 594 ± 750 days (range, 94-1702 days), and the mean duration of ventricular assist support was 112 ± 98 days (range, 44-284 days). Four patients underwent heart transplantation overseas and one died of cerebral hemorrhage. CONCLUSIONS: Careful management of pediatric VAD patients and development of a device designed specifically for pediatric patients are essential for improving clinical outcomes in the future.

[Coronary artery bypass graft for Bland-White-Garland syndrome in an old age; report of a case].

We report a case of Bland-White-Garland syndrome with advanced age. The patient, a 67-year-old women, presented with a history of congestive heart failure. Coronary catheterization revealed an anomalous origin of the left coronary artery (LCA) from the trunk of the pulmonary artery and huge right coronary aneurysm. Myocardial single photon emission computed tomography (SPECT) showed previous myocardial infarction with reversible ischemia in left anterior descending (LAD) region. We performed LCA direct closure and coronary artery bypass graft. The patient recovered uneventfully without signs of ischemia. Although a bypass graft was patent, left ventricular function had not been improved immediately probably due to the coronary flow pattern changes.